Should ophthalmologists consider treatment options beyond intraocular pressure ? What will these options be? There is normotensive glaucoma also; what should the approach be in those cases?
Glaucoma often is accompanied by increased intraocular pressure. There are some drugs decreasing pressure by decreasing tear secretion like anhydrase carbonic inhibitors for example Acetazolamide and other drugs. Others open lacrimal duct orifice so decrease pressure.
My question is different. What I mean to ask is what are the options available other than addressing IOP (decreasing production and increasing drainage of aqueous).
Currently, the only known modifiable risk factor for glaucoma is intraocular pressure(IOP) and hence is the focus of most physicians for glaucoma treatment.
But I understand why you ask this question as there is a paradigm shift in our understanding of glaucoma over the past 5 years or so. Newer drug classes like the ROCK kinase inhibitors, adenosine receptor agonists and newer prostanoid receptor agonists are also on the brink of entering markets after successful trials. Advanced modalities like SiRNA and Gene therapy has also been explored for glaucoma treatment.
What is important to note is the need for this research as glaucoma progression has been noted in several patients despite being maintained under target IOP and also invariably in NTG patients. The role of mematine, brimonidine and other neuroprotective agents has also been explored but results don't match up to the expectations. There is a lot to do yet but at the same time IOP is something that is imperative to control. These anti glaucoma drugs thus still have a very important, though quickly diminishing importance in explaining the patho-physiology of glaucoma, which unfortunately yet excitingly remains an elusive hunt for glaucoma researchers to pursue.
An excellent review of the newer drugs is attached for your reference.
The pathogenesis of Glaucoma has been explained on the basis of mechanical theory, vascular theory, biochemical theory, genetic theory, lymphatic theory, abnormal pressure gradients between the intracranial pressure and intraocular pressure, and so on. Therefore, it would be interesting to see if we can find out other treatment options apart from lowering IOP.
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